title: Extended cervical mediastinoscopy revisited.
abstract: OBJECTIVE
  To describe the diagnostic value of selective extended cervical mediastinoscopy (ECM) in combination with video-assisted mediastinoscopic lymphadenectomy (VAMLA) in mediastinal staging of potentially resectable left-sided lung carcinoma.
  
  
  METHODS
  Institutional report on 110 ECM procedures indicated for enlarged lymph nodes within the aorto-pulmonary (AP) zone on computed tomography. Staging sensitivity, negative predictive value (NPV) and specificity of ECM, combined VAMLA and ECM, VAMLA alone and systematic dissection for lung resection via left-sided video-assisted thoracoscopic surgery (VATS) or thoracotomy were calculated from a subset of 92 patients with left-sided lung carcinoma.
  
  
  RESULTS
  Selective ECM was performed in 12.6% of all video-mediastinoscopic procedures, and added, except for one vascular complication, there was no morbidity. ECM had an impact on mediastinal staging in 78.0% of the lung cancer cases. Sensitivity, NPV and specificity were 0.94, 0.96 and 1 for ECM to detect nodal involvement within the AP zone. Sensitivity, NPV and specificity to detect any mediastinal diseases were 0.94, 0.96 and 1 for the combination of ECM and VAMLA; 0.64, 0.80 and 1 for VAMLA alone and 0.76, 0.84 and 1 for systematic mediastinal dissection via left-sided VATS or thoracotomy approach.
  
  
  CONCLUSIONS
  ECM complements VAMLA in comprehensive mediastinal dissection. Selective ECM is a valuable addendum to mediastinoscopic staging procedures for left-sided tumours, as it enhances sensitivity and NPV. Precaution and experience are required to circumvent the rare risk of potentially fatal vascular accidents.
authors.affiliation: Department of Thoracic Surgery, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany.
authors.forename: Biruta
authors.initials: B
authors.lastname: Witte
authors.forename: Michael
authors.initials: M
authors.lastname: Wolf
authors.forename: Hubertus
authors.initials: H
authors.lastname: Hillebrand
authors.forename: Elke
authors.initials: E
authors.lastname: Kriegel
authors.forename: Martin
authors.initials: M
authors.lastname: Huertgen
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008481:Mediastinoscopy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D012680:Sensitivity and Specificity; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Extended cervical mediastinoscopy; Lung carcinoma; Mediastinal staging; Mediastinoscopy; Video-assisted mediastinoscopic lymphadenectomy